Background Chronic Kidney Disease (CKD), a leading public health problem, poses substantial burdens for both healthcare systems and patients. The aim of this study was to estimate the health and economic burden of CKD for adults aged 40+ years from the perspective of the Chilean public healthcare system, by adapting the Schlackow and colleagues’ CKD-cardiovascular disease (CVD) model.

Methods The microsimulation CKD-CVD model was built based on the Study of Heart and Renal Protection (SHARP). We adapted it using Chilean data, and combining two submodels. The CKD submodel included five mutually exclusive states replicating CKD progression based on the Kidney Disease: Improving Global Outcomes (KDIGO) classification: from CKD stage 3b to end-stage kidney disease (ESKD). The CVD submodel used the individuals´ annual risks of cardiovascular outcomes (both fatal and non-fatal) and non-vascular death. Both submodels were combined into a first-order Markov model with annual cycles to allow the inclusion of all the possible states between the CKD stages and the CVD outcomes. We used nationally-representative Chilean survey and registry data to adapt the model with a time horizon of 20 years, from 2020 to 2040. Costs, life-years (Lys), and quality-adjusted life-years (QALYs) were discounted using a 3% discount rate after the first year.

Results On average, an individual aged 64 years, starting with CKD stage 3b at baseline, had a projected cumulative probability of progressing to ESKD of 0.16 (95% credibility interval CI: 0.13–0.20); and projected survival of 11.9 years (95% CI: 11.2–12.5) and 8.9 QALYs (95% CI: 8.3–9.5). An individual starting in ESKD and having renal replacement therapy had projected survival of 7.7 years (95% CI: 7.0–8.4) and 5.7 QALYs (95% CI: 5.1–6.2). For individuals in CKD Stage 3b, the predicted probabilities of having a major vascular event (MVE) or vascular death (VD) were 0.14 (0.11–0.18), 0.26 (0.21–0.33) and 0.43 (0.35–0.54) in the next 5, 10 and 20 years, respectively. For individuals in ESKD, the predicted probabilities of having a MVE or VD over the same time periods were 0.31 (0.26–0.37), 0.46 (0.39–0.53) and 0.59 (0.51–0.68); mean lifetime direct healthcare costs were £70,606 (95% CI: 57,385–85,190).

Conclusion The important interdependence between CKD and CVD outcomes and the lower life expectancy and quality-adjusted survival when individuals progress to more advanced stages of the disease highlight the need for effective public health policies to address the management of the disease and its risk factors at primary and secondary healthcare level.